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Key questions: Dementia

Key questions: Dementia

Key points

  • Dementia is a progressive, life-limiting neurodegenerative disease. It is not a part of normal ageing
  • Alzheimer’s disease, vascular dementia, dementia with Lewy bodies (DLB) and fronto-temporal dementia are the commonest dementias
  • Diagnosis is helpful in tailoring treatment
  • Anticholinesterase inhibitors and memantine can help in Alzheimer’s disease
  • Although memory problems are typical, dementia can present with behaviour change or cognitive issues
  • A new diagnosis should prompt referral to local support, advice on sources of information, and discussion of lasting power of attorney arrangements 
  • Patients should be informed of their duty to notify the DVLA 

Dr Peter Bagshaw is a GP in Minehead, Somerset, and national clinical engagement chair at the Deep Dementia Phenotyping (DEMON) Network

Q: What are the main types of dementia and how does a specific diagnosis affect management?

A: Alzheimer’s disease, vascular dementia, dementia with Lewy bodies (DLB) and fronto-temporal dementia (FTD) are the main types of dementia. The remaining 5% are ‘rare dementias’.1

Early onset dementia describes dementia starting in a person under 65. ‘Mixed’ dementia is used when several types of dementia occur together. 

Alzheimer’s disease, which makes up around two-thirds of dementia cases, is characterised by memory and cognitive problems, and by the presence of amyloid and tau proteins. Vascular dementia caused by reduced blood flow to the brain has very similar clinical features and accounts for most of the rest. DLB is often associated with Parkinson’s disease and accounts for around 10% of total dementias. It is difficult to distinguish this clinically from other dementias, though hallucinations seem to be more common. FTD usually presents with behavioural or language issues before memory problems occur.

All are progressive neurodegenerative conditions with similar prognoses. The management focus in the early stages is on living well with dementia. Anticholinesterase inhibitors (such as donepezil) and memantine are only licensed for use in Alzheimer’s dementia.

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